Analysis of Diabetes Data using Extended Cox Model with Frailty under Partial and Penalized partial likelihood estimation methods

Data on Diabetes were analyzed using partial likelihood (Pl) and penalized partial likelihood (Ppl) estimation methods in non-proportional hazards model with dichotomous time-varying covariates. Gamma and Inverse Gaussian frailty distributions were used to account for patient- specific unobserved heterogeneity. Four likelihood configurations were formed from the combinations of the two estimation methods and frailty distributions. These are Partial likelihood with Gamma frailty, Partial likelihood with Inverse Gaussian frailty, Penalized partial likelihood with Gamma frailty and Penalized partial likelihood with Gamma frailty.  The results revealed that age and body mass index of the patients significantly increased the risk of death from diabetes, while regular exercise had significant decreased risk of death. Penalized partial likelihood estimation method generally outperformed models with Partial likelihood under all scenarios for the data and Gamma frailty provided a better fit in accounting for unobserved heterogeneity among the diabetic patients

Semi-Parametric Non-Proportional Hazard Model With Time Varying Covariate

The application of survival analysis has extended the importance of statistical methods for time to event data that incorporate time dependent covariates. The Cox proportional hazards model is one such method that is widely used. An extension of the Cox model with time-dependent covariates was adopted when proportionality assumption are violated. The purpose of this study is to validate the model assumption when hazard rate varies with time. This approach is applied to model data on duration of infertility subject to time varying covariate. Validity is assessed by a set of simulation experiments and results indicate that a non proportional hazard model performs well in the phase of violated assumptions of the Cox proportional hazards

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

Survey data on the knowledge, attitudes and practices of Nigerians towards the prevention and spread of COVID-19 during the lockdown period in Nigeria

There had been an urgent call for the collection of standardized data describing clinical presentations, severity, outcomes, and epidemiology of COVID-19 by the World Health Organization (WHO). These data were expected to compliment the national pandemic data collated from countries by the World Health Organization (WHO). Nigeria, among other countries, is not an exception. This survey collected data on the respondent's knowledge on COVID-19, their attitude and practices towards the control of the spread of COVID-19 amongst Nigerians. The data were collected through an online survey. There were 1320 respondents from Nigeria that answered the survey questions. The survey was conducted between March 31 and April 28, 2020 which were within the lockdown period in the country. These data could serve as auxiliary information and/or research data for other researchers in Nigeria. It could also serve as guide or reference data to other researchers outside Nigeria who may be interested in carrying out similar research in another country

Effect of intermittently scanned continuous glucose monitoring in people with diabetes with a psychosocial indication for initiation

Aim: To understand the effect of intermittently scanned continuous glucose monitoring (isCGM) in people with diabetes with a ‘psychosocial’ indication for access. Methods: The study utilized baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes in the UK. Diabetes-related distress (DRD) was assessed using the two-item diabetes-related distress scale (DDS). Participants were categorized into two groups: high DRD (DDS score ≥ 3) and lower DRD (DDS score < 3). The t-test was used to assess the difference in the pre- and post-isCGM continuous variables. Results: The study consisted of 17 036 people with diabetes, with 1314 (7%) using isCGM for ‘psychosocial’ reasons. Follow-up data were available for 327 participants, 322 (99%) of whom had type 1 diabetes with a median diabetes duration of 15 years; 75% (n = 241) had high levels of DRD. With the initiation of isCGM, after a mean follow-up period of 6.9 months, there was a significant reduction in DDS score; 4 at baseline versus 2.5 at follow-up (P <.001). The prevalence of high DRD reduced from 76% to 38% at follow-up (50% reduction in DRD, P <.001). There was also a significant reduction in HbA1c (78.5 mmol/mol [9.3%] at baseline vs. 66.5 mmol/mol [8.2%] at follow-up; P <.001). This group also experienced an 87% reduction in hospital admissions because of hyperglycaemia/diabetic ketoacidosis (P <.001). Conclusion: People with diabetes who had isCGM initiated for a psychosocial indication had high levels of DRD and HbA1c, which improved with the use of isCGM

Patterns of drugs prescribed for dental outpatients in Nigeria: findings and implications.

There are concerns with inappropriate prescribing of medicines among dentists especially antimicrobials. It is more concerning if this increases resistance rates. This study aimed to address this by assessing patterns of drugs prescribed for outpatients attending a hospital dental clinic in Nigeria. The findings will be used to plan future interventions, particularly around antimicrobial prescribing, where there are concerns.Medical records of patients attending the dental clinic of a leading teaching hospital in Nigeria were evaluated. Patients referred for admission, without a prescription, or prescribed medicines without a documented diagnosis were excluded.Overall, 607 prescriptions were analysed, 314 (51.7%) were for females. Periodontal and gum diseases (414; 68.1%) were the most frequent diagnoses, followed by pulpitis (49; 8.2%), and dentoalveolar abscess (43; 7.1%). A total of 1798 medicines were prescribed for all patients with a mean of 3.0 ± 0.48 medicines per prescription. Antimicrobials (1178; 65.5%) and analgesics (620; 34.5%) were the two drug classes prescribed. Ascorbic acid and vitamin B complex were prescribed for 361 (59.5%) patients. Among antimicrobials, amoxicillin (564; 95.1%) either alone or combined with clavulanic acid was the most frequently prescribed, followed by metronidazole (561; 94.6%). Brand name prescribing was also appreciably higher than WHO recommendations.Polypharmacy, brand name prescriptions, and the frequent prescription of antimicrobials were common practices at the dental clinic of this teaching hospital in Nigeria. We suggest a review of the current standard treatment guidelines in Nigeria to guide dentists on current knowledge- and evidence-based treatment of common oral diseases

Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study

Background: Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods: Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results: A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions: With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances